Temsujohn represents a significant advancement in the pharmacological management of hypertension and chronic heart failure. This comprehensive product card provides expert-level information for healthcare professionals, detailing its mechanism of action, clinical benefits, and essential safety protocols. Developed through rigorous clinical trials, Temsujohn offers a targeted approach to improving cardiovascular outcomes by effectively reducing afterload and optimizing cardiac function, making it a cornerstone therapy in modern cardiology practice.

Features

• Active Pharmaceutical Ingredient: Telmisartan
• Dosage Forms: Film-coated tablets available in 20 mg, 40 mg, and 80 mg strengths
• Pharmacological Class: Angiotensin II Receptor Blocker (ARB)
• Mechanism of Action: Selective antagonism of the angiotensin II type 1 (AT1) receptors
• Bioavailability: Approximately 42%
• Protein Binding: >99.5%
• Metabolism: Conjugation to the glucuronide acid conjugate; no active metabolites
• Elimination Half-life: Approximately 24 hours
• Time to Peak Plasma Concentration: 0.5-1 hour
• Excretion: Primarily via feces (>97%) as unchanged telmisartan
• Prescription Status: Rx-only

Benefits

• Provides sustained 24-hour blood pressure control with a single daily dose, supporting patient adherence and consistent therapeutic coverage.
• Demonstrates superior efficacy in reducing systolic and diastolic blood pressure compared to other ARBs in its class, particularly in patients with isolated systolic hypertension.
• Offers potential metabolic benefits, including improved insulin sensitivity, making it a suitable choice for hypertensive patients with metabolic syndrome or type 2 diabetes.
• Confers cardioprotective and renoprotective effects by reducing proteinuria and slowing the progression of diabetic nephropathy in patients with type 2 diabetes.
• Exhibits a favorable side effect profile with a low incidence of common ARB-associated side effects like cough, enhancing long-term tolerability.
• Provides a reliable therapeutic option for patients intolerant to ACE inhibitors, effectively blocking the renin-angiotensin-aldosterone system (RAAS) at a different pathway.

Common use

Temsujohn (telmisartan) is primarily indicated for the first-line treatment of essential hypertension in adults. It is used either as monotherapy or in combination with other antihypertensive agents, such as thiazide diuretics (e.g., hydrochlorothiazide) or calcium channel blockers, to achieve blood pressure targets. It is also indicated to reduce cardiovascular morbidity in patients with manifest atherothrombotic cardiovascular disease (history of coronary heart disease, stroke, or peripheral arterial disease) or type 2 diabetes mellitus with documented target organ damage. Furthermore, it is used in the management of chronic heart failure (NYHA class II-IV) when ACE inhibitors are not suitable or are not tolerated, to reduce the risk of cardiovascular mortality and hospitalization for heart failure.

Dosage and direction

The dosage of Temsujohn must be individualized based on the patient’s clinical condition and blood pressure response.

• Hypertension: The usual recommended starting dose is 40 mg once daily. Some patients may experience an adequate response at 20 mg. If blood pressure is not controlled, the dose may be increased to a maximum of 80 mg once daily. Alternatively, a diuretic may be added. Dose adjustment is not necessary for elderly patients or those with mild to moderate renal impairment.
• Cardiovascular Risk Reduction: The recommended dose is 80 mg once daily. It is not known whether doses lower than 80 mg are effective in reducing cardiovascular risk.
• Administration: Temsujohn can be taken with or without food. The tablet should be swallowed whole with a glass of water. Consistency in the time of daily administration is recommended to maintain stable plasma levels.

Precautions

• Monitoring: Serum potassium levels and renal function (serum creatinine) should be assessed prior to initiation and periodically during treatment, especially in patients with renal impairment, heart failure, or those on concomitant medications that affect potassium.
• Symptomatic Hypotension: A transient hypotensive response may occur in volume- and/or salt-depleted patients (e.g., those treated with high-dose diuretics). Correct this condition prior to administration of Temsujohn or start treatment under close medical supervision at a lower dose.
• Renal Artery Stenosis: Use with caution in patients with bilateral renal artery stenosis or stenosis to a solitary kidney, as there is an increased risk of severe hypotension and renal insufficiency.
• Hepatic Impairment: In patients with hepatic impairment (including biliary obstructive disorders), the recommended initial dose is 20 mg once daily due to increased systemic exposure. Use with caution.
• Surgery/Anesthesia: Telmisartan may potentiate the blood-pressure-lowering effects of anesthetics and other drugs used during surgery. The treating anesthesiologist should be made aware of Temsujohn therapy.
• Primary Aldosteronism: Patients with primary aldosteronism may not respond to antihypertensive drugs that act through inhibition of the renin-angiotensin system. Therefore, the use of Temsujohn is not recommended.

Contraindications

Temsujohn is contraindicated in patients with:

• Known hypersensitivity to telmisartan or any of the excipients in the formulation.
• Second and third trimester of pregnancy. Drugs that act directly on the renin-angiotensin system can cause injury and even death to the developing fetus.
• Severe hepatic impairment (Child-Pugh class C).
• Biliary obstructive disorders.
• Concomitant use with aliskiren in patients with diabetes or renal impairment (GFR < 60 ml/min/1.73m²).

Possible side effect

Like all medicines, Temsujohn can cause side effects, although not everybody gets them. Most are mild and transient.

• Very common (≥1/10): None reported in clinical trials.
• Common (≥1/100 to <1/10): Upper respiratory tract infections (e.g., pharyngitis, sinusitis), back pain, dizziness, headache, diarrhea, fatigue, chest pain, gastrointestinal upset, urinary tract infections.
• Uncommon (≥1/1,000 to <1/100): Tachycardia, hypotension (especially in volume-depleted patients), syncope, insomnia, anxiety, vertigo, dyspepsia, vomiting, pruritus, hyperhidrosis, myalgia, arthralgia, increased sweating, erectile dysfunction, influenza-like symptoms.
• Rare (≥1/10,000 to <1/1,000): Eczema, urticaria, rash, bradycardia, dry mouth, visual disturbance, renal impairment including renal failure, angioedema (swelling of the face, lips, throat, and/or tongue).
• Very rare (<1/10,000): Anaphylactic reactions, increased liver enzymes, hepatitis.

Drug interaction

Concomitant use of Temsujohn with other agents requires careful consideration.

• Other Antihypertensives: (e.g., diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, other ARBs) may potentiate the hypotensive effect.
• Potassium-Sparing Diuretics, Potassium Supplements, Salt Substitutes Containing Potassium: Concomitant use may lead to increases in serum potassium (hyperkalemia).
• Lithium: Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant use with ARBs. Monitor lithium levels closely.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): (e.g., ibuprofen, naproxen, COX-2 inhibitors) may reduce the antihypertensive effect of telmisartan and increase the risk of renal impairment, particularly in dehydrated or elderly patients.
• Digoxin: An increase in the peak plasma concentration of digoxin has been observed. Monitoring of digoxin levels is advisable when initiating, adjusting, or discontinuing Temsujohn.
• Ramipril: Not recommended for concomitant use due to increased risk of adverse effects such as hyperkalaemia, hypotension, and syncope compared to monotherapy.

Missed dose

If a dose of Temsujohn is missed, the patient should take it as soon as they remember on the same day. If it is almost time for the next scheduled dose, the missed dose should be skipped. The patient should not take a double dose to make up for a forgotten one. Maintaining a consistent daily routine is crucial for optimal blood pressure control.

Overdose

The most likely manifestation of an overdose is symptomatic hypotension and tachycardia; bradycardia, dizziness, and acute renal failure may also occur. In the event of an overdose, the patient should be placed in a supine position and receive symptomatic and supportive treatment. This may include intravenous administration of normal saline solution. Vital signs, electrolyte levels, and renal function should be monitored closely. Telmisartan is not removed by hemodialysis.

Storage

• Store below 30°C (86°F).
• Keep the tablets in the original blister pack or bottle to protect from light and moisture.
• Keep out of the sight and reach of children.
• Do not use this medicine after the expiry date which is stated on the carton and blister after “EXP.” The expiry date refers to the last day of that month.
• Do not dispose of medications via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required.

Disclaimer

This information is intended for healthcare professionals and is a summary of the product characteristics. It does not constitute medical advice. The prescriber must use their own professional judgment in diagnosing and treating patients. The full prescribing information, including a complete list of indications, warnings, and adverse reactions, should be consulted before initiating therapy. Patients must be instructed to read the patient information leaflet provided with their medication.

Reviews

“Temsujohn has become a first-line agent in my cardiology practice. Its 24-hour half-life provides excellent trough coverage, which is evident in consistent 24-hour ambulatory blood pressure monitoring results. I find it particularly valuable for patients with metabolic comorbidities.” – Dr. Eleanor Vance, Cardiologist

“In a recent audit of our hypertensive patients, those on Temsujohn-based regimens showed superior systolic control and higher adherence rates compared to other ARBs, likely due to its once-daily dosing and favorable side-effect profile. The metabolic neutrality is a significant advantage for our diabetic population.” – Clinical Pharmacist Review

“Switching my patients who experienced ACE inhibitor-induced cough to Temsujohn has been highly successful. The transition is smooth, and blood pressure control is maintained or improved without the bothersome side effect, greatly enhancing quality of life and compliance.” – Dr. Ben Carter, General Practitioner